Infertility Treatments and Financial Options: Sharing the Risks with Patients to Achieve Success

By: ART Fertility Program of Alabama, Drs. Honea, Houserman, Long and Allemand

Some people never seek fertility care because they are overwhelmed by the fact that they have infertility and by the vast array of therapies available. Only about 20% of couples need the advanced therapies of IVF or Egg Recipient cycles.

One of the biggest stresses on couples with infertility is the fear of needing fertility services that are not covered by insurance. Most services are covered to some extent except IVF and Egg Donation. Every patient who comes into the ART Fertility Program of Alabama meets with a financial counselor to understand what their insurance covers.

One of the more important contributions we have made at the ART Fertility Program of Alabama is developing our Shared Risk Refund Program for IVF and Egg Donation. This Plan is ultimately the most successful way for qualified couples who need IVF or egg donation to have a baby.  It has been well studied that most couples with infertility need two or three cycles to have a baby. Couples often stop pursuing fertility care because they are so devastated if they do not become pregnant the first cycle; or if they become pregnant and miscarry; they are overwhelmed and give up. Couples need a plan that is bigger than one cycle.  They need a plan to achieve a live birth. At least 75-80% of couples have a baby (or two) with the Plan or receive a significant refund.

The Shared Risk Refund Plan is offered for both IVF and egg recipient patients.  The Plan guarantees that if a qualified couple does not achieve a live birth, the refundable portion of the plan fee will be returned so that other alternatives can be pursued. If attempting a single cycle, couples feel that everything depends on the outcome of that one cycle. With the Shared Risk Refund Plan, the pressure is off. Couples know they can do multiple IVF or egg recipient cycles and use their frozen embryos until they achieve the outcome that they desire or have a good alternative.

It is important to point out that while the Shared Risk Refund Plan is available for egg recipients as well as IVF, they are structured differently. There is an additional fee for egg donor expenses if a second cycle is needed.  For egg recipient patients using the Plan, the process provides a similar peace of mind because they are not thinking of it as only one procedure.  They are thinking of it as a process.  And that is how you have to think about fertility.  It often takes multiple tries as shown in the Shared Risk Refund Plan.

What are Patients’ Options?

With the Shared Risk Refund Plan, couples receive the first cycle and any frozen embryo cycles if needed.  If they do not become pregnant or miscarry, they receive the second cycle and any frozen embryo cycles. This fee includes ICSI, embryo freezing and thawing and laser hatching of embryos if indicated.  If the course of care changes as a result of the findings from the first cycle, alternatives may be available to complete the Plan; for example, using donor eggs or sperm if there is a problem

identified. If they do not have a baby, they get back at least 60% of the refundable portion of the cycle. They can then use the refund to pursue another appropriate infertility direction or other options they desire. (Embryo or egg donation for failed IVF, adoption, gestational carrier). 

There is also a three-cycle Shared Risk Refund Plan for certain patient situations, which gives them three opportunities.  Certain criteria must be met to be eligible for these Plans. Those eligible must have a good number of eggs, be in a fertile age range (less than 35 unless using donor eggs), and usually must complete the Plan before they turn 35 for two cycle and 36 for three cycle.  Some are required to do the three-cycle Plan due to other specific fertility factors as their chance of pregnancy is slightly lower each cycle.

If insurance covers IVF or egg recipient services, they cannot use the Shared Risk Refund Plan. The counselor will discuss whether financial help is needed if services are not covered.  For those who do not have insurance coverage, our financial counselor will meet with them to guide them to resources that may help them with financing.  We offer counseling for all of our patients on financial issues and the different options to consider before starting any process.

We’re Here to Offer Patients a Path

Many patients don’t know about the Shared Risk Refund Plan before they walk in the door. They don’t see a clear path.  It is our job to show them their options, review expected outcomes for their unique issues and help them weigh the risks and benefits so they can choose the best path for them. And when most couples succeed in having their baby -- that is a better path!

 
 

PREVENT SKIN CANCER AND AGING

By: Gregory P. Bourgeois MD

Summertime always brings about thoughts of vacations at the beach or laying out by the pool and basking in the glowing heat of the sun by the water.  We all know that common cancers of the skin are caused from harmful UV rays from the sun, often accumulated over many years of exposure.  Along with skin cancer, the signs of aging (wrinkles, brown spots, loss of skin elasticity) are due mostly due to the UV energy from the sun.  Yet we seek out the sun because it’s our nature to do so.

Sunscreen is the most potent product that can prevent skin cancer and aging.  In June 2011 the FDA announced a series of requirements for sunscreens in order to ensure they are being marketed to consumers with correct information for sun protection. 

-The term “broad spectrum” is now used to label a sunscreen that can effectively block both UVB and UVA. This goes further than the SPF value, which reflects the ability of the sunscreen to block the UVB spectrum only (the cause of sunburns).  A sunscreen must pass a test the FDA implements to measure UVA transmission in order to be designated “broad spectrum”.  A broad spectrum sunscreen with SPF of 15 or greater can claim to reduce the risk of skin cancer and early skin aging (used with other skin protection measures) while non-broad spectrum sunscreens with SPF values between 2 and 14 can onlyclaim to help prevent sunburn.

-No longer can sunscreens be called “sunblock” or “waterproof” or “sweatproof” because this overstates their abilities.   They also cannot claim to provide protection from the sun for greater than 2 hours without reapplication or claim to provide immediate protection after application without supporting data.“Waterproof” will be replaced by “water resistant” and also indicate whether the sunscreen is effective for 40 minutes or 80 minutes while swimming or sweating based on testing. No sunscreens are waterproof because they eventually wash off!

-The standard “drug facts” label that we are all accustomed to seeing on any OTC drugs will now be placed on sunscreen bottles.

One can find that most sunscreens sold today contain the above labeling as these changes have been implemented over the last year.  Hopefully, these changes will bring the public’s attention to the long-term risks from sun damage and how to enjoy being outside in the sun safely. 

People often ask me, “Well, which one should I use?”  I recommend the sunscreen ingredients zinc oxide or titanium dioxide because they are physical sunscreens that deflect the sun’s rays and tend to be more photostable than chemical sunscreens.  These have been “microsized” to particles that are nanometers in size, so their application is very smooth without an opaque, white appearance; gone are the days of the lifeguard with white paste on their nose. Chemical sunscreens such as avobenzone, cinnamates, and ecamsule among others absorb the sun’s UV rays and convert that energy into heat that is quickly dissipated.

I hated putting sunscreen on as a kid – so greasy, sticky on your clothes and fingers, stings in your eyes and on your face, and didn’t seem to last long.  Industry has come a long way to address these concerns and has developed more elegant and robust vehicles so that those with sensitive skin won’t feel the stinging and that greasy feeling is gone.  At Shelby Dermatology we offer a wonderful line of sunscreens

by Elta MD that are all broad spectrum and have been formulated to fit the preference of any patient.  You can find more information at shelbydermatology.com.

 

Gregory P. Bourgeois MD is with Shelby Dermatology, PC
1022 First Street N Ste 201 | Alabaster, AL 35007| ( Office: 205.621.9500 | 7 Fax: 205.621.9507 |

Tornadoes tested imaging information technology at Children’s

 

 

 

 

By: Stuart A. Royal, M.S., M.D., is Radiologist in Chief at Children’s of Alabama. He holds the Harry M. Burns Endowed Chair in Pediatric Radiology, and is past president of the Society for Pediatric Radiology.

 

 

Most of us remember April 27, 2011, the day 62 tornadoes ripped through Alabama. Those violent storms killed 248 people and injured 2,219, many of them children. We at Children’s of Alabama still have vivid memories of that terrible tragedy, and we remember what helped us deal with the flood of trauma victims that day.

There were many medical professionals and working parts of the Children’s system that allowed us to bring top medical care quickly and efficiently to scores of injured patients, and new imaging information technology was one of the keys to coping with the crisis. This technology represents a huge advance for radiology, which translates into better, faster and less expensive care for patients. But we never thought we’d have to use it to that scale.

Typically, radiologists at Children’s perform 10 to 15 CT scans in an overnight period; after the tornadoes, we did 152 CT scans, 10 times the normal flow. Despite the flood of patients, these scans were done accurately, analyzed immediately and sent quickly to the specialists who needed to see them. Our system, which is made by Siemens, functioned perfectly.

Scanning the patients was one thing, but distributing the images was something else entirely. Information technology for CT scans comes in two parts—the RIS (Radiology Information System) and the PACS (Picture Archiving and Communications System).  RIS essentially handles the textual content of scans, and PACS distributes the images to places where they are critically needed, like the ICU, operating room or emergency department.

A single CT scan can produce 1,000 or more images for a single patient. Each image contains about 250,000 pixels. All those pixels have to be moved around in the computer network, and it’s essential that the information stays connected to individual patients. We had the potential for massive information overload since we were handling 10 times our normal load of data. The system handled it without crashing.

Our job during the tornado was further complicated by the fact that we didn’t know the names of some injured children who were rushed to us by people who found them alongside the road. We had to assign temporary identification. There were no mix-ups.

All this shows that you can blend cutting-edge technology into a critical medical situation and make it work.

Of course, an information system like ours is not static; it evolves. We started 10 years ago with our RIS-PACS system, and we have constantly updated it since then. Most recently, we have been connecting to clinics and hospitals within our referral network. This allows us to share CT scans between doctors, medical institutions and even other types of imaging systems that typically are unable to exchange

information because of different, proprietary software. Children’s has contracted with a cloud-based company called SeeMyRadiology. It is basically a website that allows institutions and doctors to upload CT scans into a system where they can be shared, even on iPhone and iPad apps.

For example pediatricians in Birmingham can view CT scans for patients who have been referred from hospitals in Huntsville where the scans were made. In the past, those scans were sometimes transferred with the patient by CD or not at all. Thus, CT scans often had to be repeated, and patients were exposed to more radiation, something of particular concern for children who are much more sensitive to radiation exposure than adults. The system gives physicians at Children’s immediate access to a patient’s CT scan history.

Our cooperation with healthcare professionals and facilities around the state has been cooperative in getting studies uploaded and downloaded properly. It’s extremely efficient and low cost. We use it many times a day because of the acuity of our patients and the large number of referrals we get. In addition, we use the system within our network of pediatricians for a peer review of CT scans, documents and diagnoses. It’s just another way that this new technology allows us to be more accurate and efficient—and most importantly, help patients.

Is There a Voice Doctor in the House?

 

 

By: Carleen F. Ozley, MS, CCC-SLP

Voice and Swallowing Therapist and Endoscopist

 

If you break a bone an Orthopedic is the physician you are looking for to help you. If you have joint aches and pain, a Rheumatologist is the one you need to see.  Vision problems – ophthalmologist; headaches – neurologist; heart problems: cardiologist. But who do you see if you have a voice disorder? An Ear, Nose and Throat (ENT) physician and Voice Specialist is the medical team that can best diagnosis and provide a voice plan of care for you. Today’s advanced technology in visualization of the larynx (voice box) through a quick and simple nasal or oral endoscopy examination provides the complete picture for the Voice Team to accurately assess your problems. The endoscopy exam along with a complete voice evaluation and perceptual and acoustical analysis of your voice provides the needed information for intervention and correction of the voice problem.

What is a Voice Disorder?

Most people give very little thought to how they produce their voice and even less attention to the health of their voice on a daily basis until their voice interferes with communication in their day to day lives. Voice problems have a direct effect upon occupation and personal and work relationships. Voice disorders may be accompanied by pain or discomfort in the throat area, and may have an effect upon swallowing and/or breathing. In addition to these physical and functional limitations there are also emotional constraints that voice disordered people experience. Isolation, aggravation and overall frustration may also be experienced as one attempts to communicate with a less than efficient vocal production. As a general rule, any change in voice (hoarseness/ reduced pitch range/ change in ability to raise or lower volume) or discomfort in the throat that lasts for more than two weeks should be evaluated by a team of voice care professionals.

What Causes Voice Disorders?

There are many causes of voice problems and most often the cause is multifactorial. Listed are a few of the possible causes of voice disorders:

*upper respiratory infection

*inappropriate pitch- too high or too low

*speaking too loud

*speaking for extensive periods of time

*improper breathing techniques

*chronic throat clearing and /or coughing

*excessive dryness due to poor hydration or side effects from certain medications

*smoking

*Gastroesophageal reflux disease

*Laryngoesophageal reflux disease

*psychological stress

*laryngeal cancer

*hormonal changes

*other more serious neurological problems or medical conditions

What Are Some Signs of a Voice Disorder?

*Hoarseness, roughness or rapines

*Chronic throat clearing or coughing

*Breathiness

*Vocal arrests – voice cuts off

*Inability to control vocal volume – too loud, too soft

*Feeling of lump in throat

* Pitch changes

*Decreased vocal range- can not reach higher or lower pitches

*Increased effort to talk – voice gets tired as you use it

*Heartburn

*Throat pain or discomfort after speaking or singing

Who has a Voice Disorder?

Anyone at any age may have a voice disorder. Occupational voice users (teachers, pastors, singers, speakers, etc.) are at a higher risk of developing voice disorders because of their extensive daily vocal use and their increased perception and awareness of vocal variations that may negatively affect their ability to perform their jobs. According to Ingo R. Titze, Ph.D., at the National Center for Voice and Speech, he reported a study which comprised 123,060,000 U. S. worker evaluated for voice disorders.  Interestingly, the occupation with the highest percentage of voice disorders (factory workers at 14.53%) comprised only 5.6% of clinic case load. Teachers with a prevalence of 4.2% for voice disorders comprised 19.6% of clinic case load for vocal treatment intervention. Additional occupations reported the following percentages of voice disorders: Salespeople: 12.97%;Clerical workers: 10.57% and Teachers: 4.2%.

What is the Prevalence of Voice Disorders?

There is some variation in study results but it is generally reported that as age increases there is an increase in voice disorders. Ages 45-70 years old report a 6.5% incidence (Leeks, 1982 and Marge, et al. 1985).  Often mild hoarseness or intermittent vocal changes or throat discomfort goes untreated for several years until a more persistent voice problem develops. Approximately 28million workers in the U.S. experience daily voice problems(Verdolini, K., & Ramig, L.O. (2001) Review: Occupational Risks for Voice Problems. Logopedics, Phonetics, Vocology, 26 (1):37-46. A second study estimates that 5% to 10% of the U.S. workforce would be classified as heavy occupational voice users. (Roy, N., Weinrich, B., Gray, S. D., et al. (2003,June).

How is your Voice?

Take this simple and quick quiz and find out!

*(Adapted from several validate questionnaires use in voice clinics: See Voice Handicap Index (VHI), Jacobson et al.; Voice-Related Quality of Life (V-RQOL), Hogikan & Sethuraman; Laryngo-pharygneal Reflux Symptom Index (RSI),Belafsky et al.

Answer YES or NO to the following questions based on symptoms within the last month (other than times when you’ve had a cold:

 

1. I have trouble talking loudly or being heard in noisy situations.

2. I feel a lump in my throat, like extra phlegm or something sticking there.

3. I have trouble doing my job or practicing my profession because of my voice.

4. Talking or singing takes effort/makes me tired.

5. I have to repeat myself to be understood in normal conversation.

6. My throat feels sore or achy even though I’m not sick.

7. My voice sounds higher, lower, or less flexible in pitch these days; I’m losing notes at the top.

8. I feel anxious or frustrated because of changes in my voice.

9. I have trouble being heard/understood on the telephone.

10. I have to strain, change now I use my voice, or compromise my vocal technique in order to sound the way I should.

 

IF YOU ANSWER YES TO 5 OR MORE- FIND THE VOICE DOCTOR AND VOICE SPECIALIST TEAM AS SOON AS YOU CAN!

IF YOU ANSWER YES TO 4 OR MORE QUESTIONS – TAKE BETTER CARE OF YOUR VOICE AND IF SYMPTOMS DON’T IMPROVE IN 2-3 WEEKS, FIND THE VOICE TEAM.

IF YOU ANSWER NO TO NEARLY EVERY QUESTION, CONTRULATIONS! YOU ARE IN GOOD VOCAL HEALTH. KEEP TAKING GOOD CARE OF YOUR VOICE!

 

Take care of your voice….TODAY!

 

 

Carleen F. Ozley, MS, CCC-SLP

Voice and Swallowing Therapist and Endoscopist

ExcelENT of Alabama

Birmingham, Alabama

 

Skin Care Should Begin Before the Onset of Wrinkles

By: Dr. Kelli H. Tapley

Good skin care should begin in infancy and continue throughout life. As children age, especially upon entering the hormone-riddled tween/teen years, their skin care needs change and the need to treat and prevent acne becomes as important as sun protection.

            Step one is teaching parents to avoid sun exposure in their infants. Sun-related skin changes occurring as early as the first year of life may lead to melanoma and other forms of skin cancer later in life, according to a review in July 2011 issue of Pediatrics. The “best” sunscreen depends on patient age and other factors such as level of activity. But it doesn’t work if it’s not applied and re-applied frequently. The AAP does not endorse any sunscreen in children under six months, but it can be used as a last resort when exposure cannot be avoided.

            The Environmental Working Group, an non-profit, non-partisan organization, publishes yearly reviews on the best sunscreens on its website. www.ewg.org  Their recommendations are based on products that do not contain oxybenzone, retinyl palmitate, combination sunscreen and bug repellents and are not “spray on.”  I advise parents to look for products that provide coverage from UVA and UVB rays and contain zinc oxide, avobenzone and Mexoryl SX. Some of my favorites are: CVS Baby Sun Lotion Broad Spectrum SPF 50, Aubrey Organics Natural Sun Screen Sensitive Skin Children (available at Whole Foods), Vanicream Sunscreen Sport (available on Amazon), Blue Lizard Australian (available locally at Dermatology and Laser of Alabama), Badger Kids Sunscreen (available locally at Village Dermatology). Parents should be advised to avoid sun exposure in their infants, especially during the hottest hours of the day (between 10am-4pm), seek shade when they are outside, dress in loose protective clothing and hats, and hydrate appropriately.

            Step two begins when those same children enter tween/teen years. Our focus should expand to include daily regimens aimed at prevention and treatment of skin disease, namely acne.

            Acne treatment is a business, and business is booming. While pharmaceutical reps for prescription acne medications are abundant, I have only met one who detailed products targeted at providing solid foundations for skin health. As physicians, we are left with the same resources parents are left with: media. Forbes estimated in 2010 Guthy-Renker (the makers of ProActiv) took in $800million in revenue from ProActiv alone. With celebrities such as Justin Bieber and Katy Perry claiming ProActiv improved their acne, teens and their parents credit cards are often sold on promises of clear complexions and bleached white smiles. As I tell my children, “just because you saw it on television, doesn’t make it real.” Often those same patients come in frustrated and several dollars lighter complaining about irritation and less than satisfactory results.

            The effects of acne reach beyond just the monthly credit card statements. Affecting over 50 million Americans, the scars left behind by acne are often deeper than just physical findings. Teens with acne report higher incidence of depression, suicidal ideation, anxiety, psychosomatic symptoms, including pain and discomfort, embarrassment and social inhibition. Effective acne treatment improves self-esteem, affect, body image, social assertiveness and self-confidence.

            While the number of OTC and prescription acne medication regimens are vast what we often overlook is basic skin care essentials. Think of it as mise en place. Adequately cleansing, moisturizing and protecting the skin are important weapons in our arsenal against acne in addition to the various prescription choices. Many patients will require topical antimicrobials and/or combination products, some will need more in depth treatments such as Accutane or procedural therapies which are usually administered in a Dermatologist office. But we can start the conversation during our routine visits and we can familiarize ourselves with the various options for good skin care foundations in our patients.

Dr. Kelli H. Tapley is with Birmingham Pediatric Associates

INTRBEAM

 

By: William A. Thompson, III, MD, FACS

For Stage I and II breast cancer, lumpectomy provides equivalent survival to a mastectomy, provided adjuvant radiation is employed.  According to the American College of Surgeons, greater than 25% of patients in the United States who need radiation following a lumpectomy did not undergo radiation. In Alabama, this number is greater than 40%. Traditionally, high energy radiation is delivered externally 5 days a week for up to 7 weeks.

Within the past 10 years, it has become apparent that select patients can forgo extended whole breast radiation in favor of partial breast irradiation delivered twice a day through a percutaneous catheter that the patient would wear for about one and a half weeks to 2 weeks. The optimal patients are older than 45, have a tumor less than 3cm, have negative margins of excision, and ideally would be node negative. This is certainly more convenient than 6-7 weeks, but does add the discomfort of additional surgical procedures with catheter insertion, keeping the area dry for greater than a week, and having a medical device protruding from the breast for 1 to 2 weeks.

The most recent advance is a single dose of radiation delivered in the operating room while the patient is under anesthesia. The INTRBEAM system is a small portable electronic X-ray source that delivers radiation via a spherical applicator immediately after the lumpectomy following pathologic margin assessment. The duration of therapy depends on the volume of the applicator used, typically between 25 and 50 minutes. The lifestyle advantages are obvious. Daily radiation therapy for an employed patient is inconvenient at best, and for a more infirmed or rural patient may be completely untenable.

This exciting new therapy is supported by a  greater than 2000 patient  multicenter trial presented at the American Society of Clinical Oncology meeting in Chicago 3 years ago and published in the prestigious journal, The Lancet in July 2010. A follow up presentation at the December 2012 San Antonio Breast Conference showed no breast cancer 5 year  survival benefit to receiving 6 weeks of therapy compared to a single dose intraoperatively. In fact, there was a trend for improved overall survival in the INTRABEAM arm due to fewer non-breast cancer deaths.

Currently, Trinity Hospital is the only hospital in the state and one of about 40 facilities nationwide to use the INTRABEAM.  These hospitals include Georgetown, NYH-Cornell, Florida-Gainesville, and USC-Los Angeles. A clear impediment to wider state wide use has been reimbursement. Despite a willingness to pay thousands of dollars for catheter based therapy which has far weaker data, Blue Cross/Blue Shield of Alabama has refused to pay the several hundred dollars for the INTRABEAM. That deterrent however has not prevented Trinity surgeons and radiation therapists from delivering this treatment to Alabamians many who would not have had radiation therapy otherwise.

 

 William A. Thompson, III, MD, FACS

Lower Back Pain Is A Pain In The You- Know -What

By: Dr. Mueller
Medical West Hospital

It's a pose that you have performed and seen probably thousands of times. A tensed up face, leaning to one side, and an arm hooked to holding the lower back.

Lower back pain is an extremely prevalent condition in the United States. A study from a few years back found that over the course of three months, more than 1/4 of U.S. adults have experienced lower back pain lasting at least a day. I'd wager that over the course of a lifetime, just about everyone will experience lower back pain. (It is reported to be the fifth most common reason for going to the doctor.)

In terms of what falls under the lower back pain (LBP) umbrella - pretty much anywhere from the bottom of your ribs to your legs would qualify. It can result from a herniated disc, compression fractures, overuse, strain, just getting older, and more. The pain can be a consistent, dull pain - or it can be sharp and severe. LBP can lead to some issues with your legs as well. Numbness, tingling, or pain down to even below the knee.

Aside from being a personal pain and hindrance, LBP also has a major effect in the workforce. When LBP gets to the point where it limits a person's movement or ability to perform - businesses lose productivity and money, a person may lose income (depending on their working situation), and the medical costs total in the dozens of billions of dollars a year. And if LBP pulls a person out of work, this can cause some stress upon the individual and the company! But it's not just financial stress - the idea of being out of work (even with an injury/illness) can put some people at concern for their job security.

When it comes to LBP, you've either got it for a brief period (acute) or for a long time (chronic). We usually draw the line at around three months. Acute LBP is usually handled with at-home treatment. It’s wise to know what to do when you first get back pain (ice or heat, medicines, etc.). If it is work-related, then you need to talk to your supervisor right away. Many times, it can be handled with simple first aid as discussed below.

Real quick aside on first-aid for LBP:

Heat or ice? Usually ice initially, then heat after 2-3 days, but there are many variations on this.

Medicines: Ibuprofen (Advil/Motrin) or naproxen (Aleve) or acetaminophen (Tylenol) - MAKE SURE you educate yourself on the side effects and follow doctors' or package instructions.

If you can, it's good to keep moving. If your back hurts, try to get up and walk for 10 minutes or so, if you can. Stay on flat surfaces. It you've got to sit, make sure you change positions every half-hour or so.

Chronic back pain oftentimes requires more intense and involved treatment. Acupuncture, chiropractics, massages, and such can be done. More extreme issues concerning herniated discs may call for a procedure.

People with acute LBP can usually return to work within a few days - with the understanding that they will have to be taking it easy for a little while. Under Workers’ Compensation, most times workers can return to light or modified duty after seeing the doctor. Furthermore, depending on the nature of the LBP and the type of work, some workers can return to regular duty. After return to work, individuals may still be slightly uncomfortable, but that is normal - many times it's not until normal activities are resumed that pain relief finally comes. As long as it is handled correctly, this usually works for both the business and the individual - less stress for everyone.

Depending on the type of work, sometimes changes may be made at the work station or at the work area to address any ergonomic concerns. This may be accomplished with the assistance of company Safety, Human Resources, or Engineering professionals. 

• While you probably can't avoid it forever, you can take steps to prevent LBP. Here are a few tips:
• Exercise. A strong and healthy body is less likely to be put under stress that it cannot handle.
• Learn the proper way to lift!! Legs, people!
• Maintain good posture. Sitting and standing, your body is supporting its weight properly with good posture.
• Quit smoking. Because of its effect on bone loss, smoking can make you weaker in your spine and increase your chances of getting hurt.
• Low-heeled shoes. May or may not be as stylish, but your back doesn't care about style. A protective sleeping position. If you are on your side, try a pillow between your knees. For those of you that sleep on your back, perhaps a small pillow or shirt/towel rolled up to support your back. (Also - try a stiffer/softer mattress. Can make a world of difference.)
• Maintain a healthy weight - less strain on your body.

Lower back pain is prevalent in society, and yeah, you'll probably run into it at some point. But take the steps to reduce your chances and be sure you follow the proper treatment when you do get it. Being in pain all the time is no fun.

Take care,

Dr. Mueller

Please visit _ http://www.medicalwesthospital.org/lbp.php